Canadian doctor sees positive developments

It is hard to think of medical advancement coming from tragedy, but that’s exactly what’s happening with physical therapy in Haiti, according to a Canadian professional who has worked in the country.

Shaun Cleaver, co-ordinator of rehabilitation services development with Haiti’s Hôpital Albert Schweitzer (HAS) says physical therapy has become more recognized and respected among the local population since the Jan. 12 earthquake.

“Things have really changed,” said Cleaver, who was in St. John’s at the recent Canadian Physiotherapy Association national conference hoping to draw colleagues to work with him in Haiti.

“I’ve been there for a few years now and … I feel I need to preface this, because it sounds weird, the earthquake being an awful thing … but for physiotherapy and rehab, the needs have been there for years. They’ve gone unrecognized for far too long and at least this tragedy has brought light to things that existed, the problems that we had already that need to be addressed,” he said.

Both HAS and Cleaver’s community of Deschappelles are in the Artibonite Valley area of central Haiti. With its fertile valley used for rice growing, the population has traditionally been made up primarily of subsistence farmers. There are also some mountainous regions, less fertile and more difficult to reach.

“We’re responsible for referral care for about 300,000 people and then primary care for a smaller portion of that,” Cleaver said of the health organization.

“My job is to develop programs and to help facilitate local ownership, so that I can leave and go on to the next thing.”

Cleaver has been working to train physical therapists and develop therapy programs throughout the health organization’s coverage area.

It was slow going at first, he said.

“The key point to note is that there were not a lot of initiatives in rehab and physiotherapy, so it was really at the forefront of trying to create domestic capacity. And I did have the good fortune of having a few physiotherapy colleagues, primarily Americans, who had already started building things up, but most of them were there for short periods of time — two weeks, four weeks, six weeks,” he said.

“Their involvement was primarily in training, and the type of care provider we were looking at developing is called a rehab technician and that’s a nine-month program that has basic elements of physiotherapy as well as some other professions integrated, such as occupational therapy and speech therapy. The idea being, with there being a near absence of people doing our type of work, it was a level that we could train fairly quickly that could begin to start doing the type of work that we do.”

Yet the care providers and instructors were hitting a hurdle, Cleaver said, in that within the communities, there were few people to show the potential benefits of physiotherapy.

“The status quo idea in Haiti — with stigma related to disability and without there having been a presence of rehab — is that these people are either going to get better and be able to walk off the bed and go home, or they’re going to be damaged. It’s very polar,” he said.

Cleaver said physical therapy in some cases means saving lives. For example, potentially dangerous lung infections can occur after a spinal injury.

“If you spend all of your time lying down, you’re a great germ receptacle. And then, on top of that, especially if you’re injured from here up (he places his hand across his lower stomach), you don’t have the same amount of abdominal muscle function to help you cough. So once something develops, it’s a lot harder to get rid of,” he said.

“In that (early) phase, that’s primarily what we do, is to make sure bad things don’t happen. … Our status quo previous was though early things weren’t done, the potential for what people could do wasn’t introduced, so generally the medical problems would ensue, we wouldn’t be able to beat them and we would lose people within six months,” he said.

“The public attention that’s garnered the increase in resources, that has been very valuable. I’d like people to know that we’ve made progress and if that awareness and those resources are maintained, we can do more.”— Shaun Cleaver, co-ordinator of rehabilitation services development, Hôpital Albert Schweitzer

“Those are people, if given opportunities, even in our low-resource environment in Haiti, that could be completely functional,” Cleaver said.

“It’s a tough reality to swallow at first, but that’s where professionally the drive comes to stay involved and to know that there’s the potential to do these things better. That’s my motivation to recruit more of my colleagues to be involved in this type of work.”

Cleaver worked in Haiti for six months in 2003, for a year in 2004-2005, a couple of short terms in 2006 and 2007 and another year-long run in 2008-2009. He was not in the country during the earthquake, but heard what happened in his area.

“The key to our area is that we suffered very little physical damage in the earthquake. What we had instead was a flood of internal refugees leaving the capital, where they lost their house, lost family members, everything. So our 80-bed hospital had 800 in-patients two days after the earthquake,” he said.

“The earthquake happened Jan. 12 and I arrived (back in Haiti) Jan. 30. So as far as the most chaotic time, I had the good fortune or the bad fortune — and I go in waves as to how I feel about it — of missing most of it. We were down to maybe about 200 or 250 patients when I arrived.”

That number is still over three times the people Cleaver had seen in the waiting areas in the past.

“It’s just the volume, sheer volume. We’d see a couple of major fractures a week in our normal operations. Well, now there are hundreds, all at the same time,” he said.

And the flow of people did not reduce quickly.

“The reality was many people waited for weeks with broken bones,” he said.

While there was a new challenge in the number of people needing assistance at the hospital’s main site as well as in the countryside, Cleaver said people were asking for therapists. The groundwork laid since 2003 channelled them to people who could help and additional resources flowing into the country were plentiful enough to allow for some distribution outside the capital.

“Now we’re seeing people in mid- to-late followup phase, however you like to call that. The biggest cause of stress are the spinal cord injury survivors and that’s a patient population we can actually treat far better now than we could pre-earthquake,” he said.

“I think people should be aware that the issues of disability and lack of health care are long-standing in Haiti. I think they should be aware that because of this tragedy, it’s brought them to light in the public perception and we’re making in-roads, but there’s a lot to go,” he said.

“The public attention that’s garnered the increase in resources, that has been very valuable. I’d like people to know that we’ve made progress and if that awareness and those resources are maintained, we can do more.”

Cleaver said another area for advancement in Haiti would be communication between medical providers and better record keeping, yet a few more working physiotherapists would be a fine start.

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Alan Waterman

July 28, 2010 - 08:33

Many patients with partial spinal cord damage are left with a poorly functioning hemiparetic hand. This means they have difficulty in doing everyday functional living tasks. There are several new technologies including for neuromuscular rehabiliation including robotic therapy. However these items are very expensive. The HandTutor can be used in cases of S troke, brain and spinal cord injury, Cerebral Palsy, Orthopedic hand/ arm surgery where there is upper limb impairment. The HandTutor is a glove and dedicated rehabilitation software that uses biofeedback to improve hand function. The HandTutor encourages patients to perform exercises customized to their finger and wrist movement impairment. Doing customized exercises in a motivating environment ensures that the patient is encouraged and motivated to continue intensive exercise practice. The HandTutor is used in hospitals and community clinics and through tele-rehabilitation. Maybe a donor can be found to send the HandTutor system to Haiti?